Plagiocephaly

What is Plagiocephaly?

Plagiocephaly is a “malformation of the head marked by an oblique slant to the main axis of the skull”. The Term has also been applied to any condition characterized by a persistent flatten spot on the back or one side of the child’s head.

What causes Plagiocephaly?

Up until about one year of age, the bones of your baby’s head are very thin and flexible. This makes your baby’s head very soft and easy to mold. For the first few months of life your baby will not be strong enough to roll over on his own. If your baby prefers to look in one direction or if your baby is always on his back, part of his skull may become flat. This flattening is caused by constant pressure on one part of the skull. This is called positional plagiocephaly. Your baby may also develop a flat spot if he spends long periods of time in a car seat or reclining seat.

You may start to see flattening when your baby is only four to six weeks old.

The diagnosis begins with an examination by a pediatrician, pediatric neurosurgeon or craniofacial surgeon. A primary objective of the examination is to rule out craniosynostosis (a condition that requires surgical correction). The initial examination involves questions about gestation and birth, in utero position, neck tightness and post-natal positioning (for example, sleeping position). The physical examination includes inspection of the infant’s head and may involve palpation (carefully feeling) of the child’s skull for suture ridges and soft spots (the fontanelles) as well as checking for neck tightness and other deformities. The physician may also request x-rays or computerized tomography (a CAT scan, a series of photographic images of the skull). These images provide the most reliable method for diagnosing premature suture fusion (craniosynostosis). In addition, the physician may make (or order) a series of measurements from the child’s face and head [more on cranial anthropometry]. These measurements will be used to assess severity and monitor treatment.

To prevent your baby from developing a flattened skull, change his position often. Put your baby on his tummy to play several times a day. Use a firm play surface such as a carpeted floor or an activity mat on the floor. “Tummy time” will also help your baby:

Develop early control of his head

Strengthen the muscles in the upper body

Learn to roll over

Reach for objects

Learn to crawl

You can also put your baby on his side to play. To keep your baby on his side, put a firm rolled-up towel or blanket behind his back.

Specific treatment will be determined by your child’s physician based on the severity of the deformational plagiocephaly. Frequent rotation of your child’s head would be the first recommendation once your infant has been diagnosed with plagiocephaly. Alternating your infant’s sleep position from the back to the sides, and not putting infants on their backs when they are awake may also help prevent and treat positional plagiocephaly. Some cases do not require any treatment and the condition may resolve spontaneously when the infant begins to sit.

If the deformity is moderate to severe and a trial of re-positioning has failed, your child’s physician may recommend a cranial remodeling band or helmet.

How does helmeting correct deformational plagiocephaly?

Helmets are usually made of an outer hard shell with a foam lining. Gentle, persistent pressures are applied to capture the natural growth of an infant’s head, while inhibiting growth in the prominent areas and allowing for growth in the flat regions. As the head grows, adjustments are made frequently. The helmet essentially provides a tight, round space for the head to grow into.

How long will my child wear a helmet?

The average treatment with a helmet is usually three to six months, depending on the age of the infant and the severity of the condition. Careful and frequent monitoring is required. Helmets must be prescribed by a licensed physician with craniofacial experience.